Today is my grandmother's 86th birthday. And by 86 I clearly mean 35 and holding. Eighty-six years of magnificence. She gave me all of my good looks, intelligence and humility. I'm the most humble guy there is. My grandmother scoffed at the national life expectancy for the United States, which was 80 for a female last time I checked - Haiti is a touch under 63. She has a new knee and some arthritis in her hip, but otherwise is looking to eclipse the century mark.
And I tell you this not because I want to brag about my awesome grandma. This is a blog about my experience in Haiti, so naturally I have to make some connection. I've seen patients here that claim to be as old and older than my grandmother. I've seen patients who claim to be twenty years her junior but look older than her. The latter is far more common. Yes, people don't always know when their birthday was. The sense of time and calendars is more of a loose idea in Haiti.
But honestly, what do they really need calendars and clocks for? As it stands, I'm sitting outside on my computer, it's 7 pm and the only light coming from anywhere but our generator is the reflection in the sky of Port-au-Prince, almost 50 km away (And I know all about that 50 km if you check out my post "48.6" #memories #sortof). So what good is a clock when your day is completely governed by sunlight? The unemployment rate is one of the highest in the western hemisphere, so days aren't scheduled around jobs. Budgets are constructed on a day to day, or maybe weekly, basis. The market is in town on Wednesdays and Saturdays, but very few events are scheduled on a month to month basis. Heck, I don't need a calendar except it's a reminder of when I run out of time for my project. I already forgot my malaria meds once, so I'm clearly not paying that great attention to days. I don't have tv programs to keep me oriented, but neither do the Haitians. I'm not gonna lie, it's not a bad way to live. You just focus on the day at hand and appreciate the small things.
When it comes to appreciating things there is one patient that sticks out in my mind. The gentleman was over 90. He'd lived a hard life, and like my grandma had obliterated the national life expectancy for his native country, but still looked like he had another 10 years in the tank. He came to our clinic for a couple reasons: chest pain and a hernia. Naturally I'm more worried about the chest pain than a hernia as it can kill someone. I ask the standard questions: Onset, Location, Duration, Character, Alleviating, Radiation, Timing, other Symptoms. After all the translation I calculate an equivocal score in my mental tally for probability of cardiac etiology. He's hypertensive. Boom, let's just control his blood pressure (systolic was over 200 - not a record for my time in Haiti but certainly not healthy) and add on a baby aspirin. Beyond that we'd probably be doing more harm than good. #PrimumNonNocere. Let's go look at that hernia.
It's massive. And bilateral. He's been rocking these things for years. I don't think I need to go into detail as to why he's a bad surgical candidate. Besides the fact that no surgeon wants to put an MI waiting to happen on their OR table, his hernia is enormous and still reducible. The bigger the hernia the lower likelihood it has of causing major problems like incarceration. I tell the guy all this information and he seems okay with by recommendation against a surgery. But like any good physician should do, I ask about how it impacts his quality of life. "Do you have any problems peeing?" "No." "Is it troublesome to walk and get around." Obviously it is uncomfortable, and it causes pain on his inner thigh. I'm not surprised. "Can you still have sex?" He cracks up. I've never seen a man his age laugh the way he did when I asked him that question. He was doubled over at the waist and stomping around. "Yeah, we (he and his wife) can still have sex." He says this in between smiles and giggles. I would like to brag about taking the professional high road, but the room kinda devolved into a boys club, commending him on his sexual prowess and teasing him about the subject at the same time. His happiness was too much for me to hold back. If he had had teeth, they would've been shining. His eyes sparkled, but that was probably due to the cataracts. He got a kick out of me and my questions. I got a kick out of his attitude. #Refreshing.
It's important to have patients like these as a physician. Being a doctor is a great job. You have a role in people's lives that is very intimate and there is a great deal of responsibility and reward that accompany that. Sometimes medicine can destroy you. Especially medical school. I can't testify to much else beyond med school, but I have to think it's there too. But occasionally you get a patient like this that totally refills your tank and you can practice medicine for months without burning out. Go ahead, ask your doctor if they ever had patients like this and I will bet you they say yes.
We gave him a pack of hydrochlorothiazide and told him to come back to our clinic in a few weeks. I haven't seen him yet. I may never see him again, which would totally defeat the purpose of giving him blood pressure medication. But I can hold on to his laugh and smile until I stop practicing medicine. And I'll have to, because medicine is a grind - there are more bad days than good. Thankfully, good days like this help you forget about all the bad ones. #HealingPowerOfHappiness #HappyBirthday #LoveYouGrandma
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